Supporting Statement--0623

Supporting Statement for Form SSA-827

Authorization to Disclose Information to the Social Security Administration (SSA)

20 CFR 404.1512 and 416.912

OMB No. 0960-0623

A. Justification

1. Sections 205(a) and 1631(d)(1) of the Social Security Act (the Act) provide the Commissioner of Social Security with full power and authority to make rules and regulations, establish procedures, and adopt reasonable and proper rules for the nature and extent of the evidence as well as the methods of taking and furnishing the same to evaluate the alleged disability. For SSA to obtain evidence, a claimant must authorize his or her medical or other source(s) to release the information to SSA. Sections 223(d)(5)(A) and 1614(a)(3)(H)(i) of the Act provide that claimants have to furnish such medical and other evidence as the Commissioner of Social Security may require to prove that they are disabled. Section 223(d)(5)(B) of the Act states that the Commissioner shall consider all evidence available in such individual's case record. Implementing disability regulations 20 CFR 404.1512 and 20 CFR 416.912 of the Code of Federal Regulations specifically state that an individual is to furnish medical evidence and, if asked, evidence of age, education and training, work experience, daily activities, efforts to work, and any other evidence showing how his or her impairment(s) affects the ability to work, or for a child, the ability to function.

2. The SSA-827 is the form that provides authorization from claimants for sources of medical and other information, including schools, to release such information to SSA. Generally, the State Disability Determination Services (DDS) office sends the form(s), signed and dated by the claimant, to the designated source(s). The respondents are applicants for title II benefits and title XVI payments.

3. The SSA-827 is currently available on the Internet in a PDF format, so the claimant can print a blank form, complete it, and forward the form back to SSA for processing. SSA had originally intended to develop a printable, fillable version of the SSA-827 for use by claimants filing for disability benefits using the Internet Social Security Disability Report, (ISSDR), but the Health Insurance Portability and Accountability Act (HIPAA) mandates that health care providers can only release records when they receive a signed authorization. SSA does not currently have a technical solution to authenticate our claimants so they cannot “electronically sign” the medical release form. SSA has introduced a legislative proposal to make the process more efficient.

4. The nature of the information being collected and the manner in which it is collected preclude duplication. There is no other collection instrument used by SSA that collects data similar to that collected here.

4. This collection does not have a significant impact on a substantial number of small businesses or other small entities.

4. SSA’s disability program could not operate without this information collection. If this information were not collected, SSA would not be able to receive claim-related information from third parties because the Health Insurance Portability and Accountability Act requires proper authorization. Since the SSA-827 is only used on an as needed basis, the information cannot be collected less frequently.

4. There are no special circumstances that would cause this information collection to be conducted in a manner that is not consistent with

5 CFR 1320.5.

4. SSA published the 60-day advance Federal Register Notice on July 11, 2008, at 73 FR 40005, and SSA received no public comments. The second Notice published on September 17, 2008, at 73 FR 53919. There have been no outside consultations with members of the public.

To obtain advice from outside the Agency, SSA, as needed, consults with the Department of Health and Human Services, the Department of Education, the Department of Veterans Affairs, the American Health Information Management Association, and our State DDSs.

4. SSA provides no payment or gifts to the respondents.

4. The information requested is protected and held confidential in accordance with 42 U.S.C. 1306, 20 CFR 401 and 402, 5 U.S.C. 552 (Freedom of Information Act), 5 U.S.C. 552a (Privacy Act of 1974), and OMB Circular No. A-130.

4. The information collection does not contain any questions of a sensitive nature.

12. Respondents to the SSA-827 collection request usually complete four forms. SSA estimates that it takes a claimant 10 minutes to read both sides and sign the initial SSA-827. However, once a claimant reads the first form, it takes considerably less time to date and sign the subsequent forms because the forms do not have to be read again. SSA estimates the signing and dating of the three additional forms at 1 minute per form, resulting in three additional minutes. Therefore, the total time it takes to complete four SSA-827's is 13 minutes. In addition, SSA estimates that, of the total number of respondents, 586, 232 use the Internet and take 3 minutes to read the explanation of the SSA-827 on the Internet. A complete breakdown of the burden estimates follows:

Reading, Signing, and Dating the 1^st SSA-827 (10 minutes)

Total Respondents	Number of Reports by Each Respondent	Total Annual Responses	Estimated Number of Minutes Per Response	Total Burden Hours
3,853,928	1	3,853,928	10	642,321

Signing and Dating Three Additional SSA-827s

Total Respondents	Number of Reports by Each Respondent	Total Annual Responses	Estimated Number of Minutes Per Response	Total Burden Hours
3,853,928	3	11,561,784	1	192,696

Reading the Explanation of the SSA-827 on the Internet

Total Respondents	Number of Reports by Each Respondent	Total Annual Responses	Estimated Number of Minutes Per Response	Total Burden Hours
586,232	1	586,232	3	29,312

Collectively:

Number of Respondents: 3,853,928

Frequency of Response (Average per case): 4

Number of Responses: 16,001,944

Average Burden Per Response: 13 minutes to complete all 4 forms

Average Burden to Read Internet Instructions: 3 minutes

Estimated Annual Burden for Reading Internet Explanation: 29,312

Estimated Annual Burden to read instructions and complete the form: 864,329 hours.

The total burden is reflected as burden hours, and no separate cost burden has been calculated.

13. There is no known cost burden to the respondents.

13. The annual cost to the Federal Government is approximately $23,740,196. This estimate is a projection of the cost for printing and distributing the collection instrument and for collecting this information.

15. There are no changes in the public reporting burden.

15. The results of the information collection will not be published.

15. OMB has granted SSA an exemption from the requirement that the expiration date for OMB approval be printed on its program forms. SSA produces millions of public-use forms, many of which have a life cycle longer than that of an OMB approval. SSA does not periodically revise and reprint its public-use forms (e.g., on an annual basis). This exemption was granted so that otherwise useable editions of forms would not be taken out of circulation because the expiration date had been reached. In addition, government waste has been avoided because stocks of forms will not have to be destroyed and reprinted.

15. SSA is not requesting an exception to the certification requirements at 5 CFR 1320.9 and related provisions at 5 CFR 1320.8(b)(3).

B. Collection of Information Employing Statistical Methods

Statistical methods are not used for this information collection.

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